A-Z Allergies

Anaphylaxis

Anaphylaxis is the most severe form of allergic reaction, often affecting several parts of the body, including either breathing difficulties, a sudden drop in blood pressure, or both.

Symptoms typically occur within 30 minutes of exposure, often within five minutes, and usually develop rapidly.

It is rare for the onset of symptoms to be delayed for hours after exposure.

If you are at risk of anaphylaxis, you should be prescribed an adrenaline auto-injector (EpiPen), and provided an Anaphylaxis Action Plan. This will need to be filled in and signed by your doctor (GP or specialist). Samples of Action Plans are below. More information on EpiPens further down the page. Click on the Action Plan below to see the signs and symptoms of anaphylaxis and the emergency steps to take.

June 2017: A reduction in the injection time for EpiPen®s from 10 to 3 seconds has been approved for New Zealand and Australia. Go here

Invidivual Action Plans

How do I get an EpiPen?

EpiPens are a restricted medicine in New Zealand, but not funded by PHARMAC. This means you can buy them from a pharmacist with or without a prescription. The pharmacist will need to take some details of the patient (because it is a restricted medicine). Some NZ pharmacies, including online, carry stock but many will need to order it for you. EpiPens have an expiry date. You can check the current expiry dates on the Mylan NZ website:

Common causes include foods such as peanuts, tree nuts, sesame seeds, fish, shellfish, dairy products and eggs. However, many other foods can also cause severe reactions.

Non-food causes include wasp or bee stings, natural latex (rubber), penicillin or any other drug or injection. In some people, exercise can trigger a severe reaction - either on its own or in combination with other factors such as food or drugs (e.g. aspirin). Exposure to cold (usually cold water) can also trigger anaphylaxis. In some cases, a trigger can’t be found and this is referred to as idiopathic anaphylaxis.

What exactly is going on?

Any allergic reaction, including the most extreme form, anaphylactic shock, occurs because the body's immune system reacts inappropriately in response to the presence of a substance that it wrongly perceives as a threat.

An anaphylactic reaction is caused by the sudden release of chemical substances, including histamine, from cells in the blood and tissues. These cells are mast cells and basophils.

The release is triggered by the reaction between the allergic antibody (IgE) with the substance (allergen) causing the anaphylactic reaction. The released chemicals act on blood vessels, resulting in dilatation (opening up) of the vessels.

The skin can become red and, with fluid leakage from the vessels, tissues may become swollen. This is common around the eyes and mouth. There may be a fall in blood pressure and, especially in asthmatics, there may be wheezing and narrowing of the airways.

Some reactions are caused by direct effects on the mast cells/basophils, e.g. allergic reactions to aspirin and other anti-inflammatory drugs.

Why does adrenaline work?

Adrenaline works by strengthening the heartbeat, opening up the airways and raising blood pressure.

Adrenaline (epinephrine) is the recommended first aid drug for anaphylaxis.

Antihistamines treat hives and runny nose but not anaphylaxis and should never be used instead of adrenaline for anaphylaxis. If you have an asthma inhaler (e.g. Ventolin) use this after your adrenaline auto-injector (EpiPen or Anapen) for breathing problems, not before.

How do I know if I am at risk from anaphylaxis?

If you have suffered a severe allergic reaction in the past – whatever the cause – then any future reaction may be severe. If you have suffered a significant reaction to a tiny dose, or have reacted on skin contact, this might also be a sign that a larger dose may trigger a severe reaction. If you have asthma as well as allergies, this can put you in a higher risk category. Where foods such as peanuts, nuts, seeds, shellfish and fish are concerned, even mild symptoms should not be ignored because future reactions may be severe.

How likely is a person to die from anaphylaxis?

Although anaphylaxis is not uncommon and can be life-threatening, deaths are rare. The risk can be reduced with proper precautions: avoiding your triggers and prompt treatment with adrenaline. Overseas studies have found that co-existing asthma has a major part to play in deaths, so it’s important that you keep your asthma well controlled, even if it’s mild. Be careful, not fearful.

How do I get a diagnosis?

Your doctor will normally ask a series of questions that may help to narrow down the list of likely causes such as foods or medicines consumed that day, or insect stings. This approach will also help to exclude conditions that can sometimes be confused with anaphylaxis, like fainting or panic attacks. If allergy is suspected, this may be followed by allergy tests, usually by skin prick tests or blood tests (CAP/RAST), to help confirm or exclude potential triggers. You may be referred to a specialist.

How can I avoid problems?

The two main steps in managing anaphylaxis are to avoid triggers while at the same time being prepared for a severe reaction.

Once you know what the trigger for your anaphylaxis is, you will need to know where and how you may be exposed to it and minimise this risk as far as possible. Your doctor may be able to provide information and advice. If you have a food allergy, you may be referred to a dietitian.

Allergy New Zealand also has information, resources and support that may help (details below).

How can I be prepared?

• If you are prescribed adrenaline — either in the form of an auto-injector or an ampoule, needle and syringe — always carry it with you and make sure you know how to use it. Ask your doctor or pharmacist to show you. Auto-injector (EpiPen) trainers are available.

• Make sure your adrenaline is up to date, and remember to replace it as soon as it expires.

• Have an Anaphylaxis Management Plan signed by your allergy specialist, paediatrician or GP. This outlines mild, moderate and severe symptoms and exactly what to do when each of these develop. You can download a copy from the Australasian Society of Clinical Immunology and Allergy. Have this available for family and friends — put it on the bulletin board at home; carry one in your pocket. If a child is the person at risk, make sure his or her teachers and friends’ parents have a copy - along with the adrenaline. Make sure everyone knows where the adrenaline is when you go out, or when you are at home.

• Do the e-anaphylaxis online traininghere - it's FREE! And encourage your family and friends to do it.

• Be alert to all symptoms and take them seriously. Use adrenaline if you think you are beginning to show signs of a severe reaction. Do not wait until you are sure. Even if adrenaline is administered, you will still need to get to hospital as soon as possible. Someone must call an ambulance.

• Make sure others in your family know how to administer the adrenaline — and when. Do not be frightened of adrenaline. It is a well-understood drug. The dose you will administer has few side effects, which will pass quickly in any case. It is a safe drug for most people, although it may not be prescribed if you have a heart condition or are being treated for high blood pressure.

• Wear a MedicAlert bracelet

• Be open about your allergy problem with your family, friends and colleagues.

• If you are allergic to insect stings, your doctor may recommend allergen-specific immunotherapy, or desensitisation. Venom immunotherapy provides over 95 per cent protection against severe reactions. Immunotherapy consists of injecting increasing quantities of venom over several weeks, or in the case of “rush immunotherapy” over the course of a couple of days. Once a maintenance dose is reached, the injections can be spaced out over longer intervals. The advice of an allergy specialist should be sought prior to undertaking desensitisation. The cost of the venom vaccine is covered by Pharmac.

What does ACC cover?

A Guide to ACC Cover for allergic reactions as personal injury caused by accident (PICBA) can be downloaded here

ACC may accept claims in relation to an anaphylactic reaction based on

As a severe reaction, it causes a personal injury, and

Is caused by accident (see guide for more detailed explanation of ‘accident’)

ACC will not cover allergic reactions that are of a mild to moderate nature, such as (but not limited to) itching, rashes, sneezing and hay fever and all underlying allergic conditions. The exception is where the allergy itself may have been caused by a work-related gradual exposure, or as a result of treatment by a registered health professional. A special assessment will be required for such claims.

In general, claims will relate to the costs of emergency treatment. For patients, this will be the cost of using their own EpiPen as part of the treatment (ambulance and hospital/medical costs will be covered automatically by ACC).

If the anaphylaxis event causes a long-term injury, the patient may be entitled to the range of entitlements available under ACC, which includes treatment, social rehabilitation, vocational rehabilitation, and weekly compensation.

To make a claim, the patient/claimant will need:

Their copy of the ACC claim form filled in and signed by the doctor at the Emergency Department (ED) and/or the clinical notes relating to the event; these should include a record of the adrenaline administered using the patient’s own EpiPen. ED will submit the claim to ACC, but the patient will need to contact ACC to follow up a claim for reimbursement of the EpiPen.

A description of the event i.e. where, when, and in what circumstances the allergen concerned was ingested or injected, symptoms experienced, and treatment etc.

Receipt for the purchase of the EpiPen that was used

A copy of the patient/claimant’s pre-signed ASCIA Anaphylaxis Action Plan (this will help with the claim as it confirms they were at risk of anaphylaxis to a particular allergen and therefore increases the likelihood they were accidentally exposed in the circumstances; and that the EpiPen was used appropriately i.e. as per the Anaphylaxis Action Plan.

Contact us on allergy@allergy.org.nz or 0800 340800 if you have any questions or need further information or advice